Morbid obesity is defined as body mass index (BMI) at or over 40. Unfavorable neck anatomies of the patient are considered counter indication for percutaneous tracheostomy and they are referred for opening of surgical tracheostomy. In our case report, problems encountered in a morbid obese patient who could not be extubated due to post operative respiratory problems and the use of frova catheter (COOK, USA) in this procedure is discussed. A 42 old female patient at the weight of 246 kg. with BMI 89.4 could not be extubated due to respiratory causes post operatively and she was transferred to operating theater for surgical tracheostomy. After tracheostomy was opened, due to unsuitable anatomy associated with thick fat tissue on the neck the tracheostomy cannule couldn’t forwarded from tracheostomy hole, frova intubation catheter was sent and over it, 8 no endotracheal tube was sent in order to aerate the patient. Opening of tracheostomy in the morbidly obese is challenging operation due to specific anatomic conditions. Frova intubation guide helps in difficult intubation cases and was reported to be used for retrograde intubation in patients in whom antegrade intubation was not possible. In morbid obese patients, opening tracheostomy and then cannulating is difficult. Frova intubation guide can be used for difficult intubation in morbidly obese patients. In addition, as in the present case, it can be used in conditions in which tracheostomy cannula is too short or could not be placed during tracheostomy procedure.
Gastrointestinal stromal tumours (GIST) are rare mesenchymal neoplasms in the gastrointestinal tract. The metachronous existence of GIST and gastric adenocarcinoma, though are tumours of distinct histotype, and very rare, have been reported in medical case reports in recent years.
We report a case of a 74 year old man who initially presented with moderately differentiated adenocarcinoma of the stomach, underwent Billroth 2 gastrectomy followed by chemotherapy. Subsequently, after 15 months he developed a GIST of small bowel with metastasis from adenocarcinoma of stomach.
Taking into consideration the fact that metachronous occurrence of GIST of the gastrointestinal tract and adenocarcinoma of stomach is rare and further metastasis of one tumour into the other makes this case a rare one as per available literature.
Gall bladder dyskinesia is a clinical condition, refers to presence of biliary pain in absence of gallstones. Current evaluation and management of this condition is controversial. This article explores the current evidence available in the evaluation and treatment of such patients with emphasis on selection of patients who would benefit from cholecystectomy.
Urinary alkalinisation is a common practice in the management of dysuria in patients with urinary tract infection. Although there is wide empirical experience with this approach, scientific literature is limited. The mechanisms by which modifying urinary pH reduces dysuria are still poorly understood. This brief review examines the theory and practical implementation of urinary alkalinisation in patients with infections of the urinary tract and dysuria.
Although metformin is currently one of the most frequently prescribed drugs for the treatment of type 2 diabetes, the precise mechanism of its molecular action is not fully understood. Metformin induces mild and transient inhibition of mitochondrial respiratory-chain complex I activity, resulting in the activation of adenosine monophosphate-activated protein kinase (AMPK) and suppression of hepatic gluconeogenesis. However, recent studies provide evidence that several AMPK-independent pathways may be involved in the action of metformin.
The aim of this review is to summarize novel findings on the mechanisms of the anti-hyperglycemic action of metformin, with a special attention paid to AMPK-independent pathways. The results of recent studies with gut-restricted delayed-release metformin formulation demonstrating dissociation of its glucose-lowering effect from plasma exposure are also discussed. The role of the gastrointestinal tract in the action of metformin is summarized focusing on the enhanced secretion of glucagon-like peptide-1 and modulation of gut microbiota.
Recent scientific evidence extends our understanding of the complex mechanisms of metformin action, points towards potential new molecular targets for the treatment of diabetes and may promote the development of new antidiabetic therapies.
This mini-review summarises the risk factors for acquiring Respiratory Syncitial Virus (RSV) infection, and describes the harmful effects of the infection in pre-term infants. Moreover, theoretical considerations are discussed for the prevention of RSV infection in high-risk infant categories, such as pre-term infants.
Background: Neonates positive for RSV are more prone to severe infection than neonates infected with other common respiratory viruses. Despite RSV infection being more common in late neonates than in early ones, pre-term infants ≤ 35 wk gestational age (GA) are at high risk for developing severe RSV disease. Efforts to prevent infection include case management, vaccination and the identification of risk factors. The morbidity and mortality risks of RSV disease are highest in pre-term newborns with other underlying disease, such as bronchopulmonary dysplasia (BPD) or hemodynamically significant congenital heart disease (hsCHD). Associations between RSV-positive neonates and climate factors are also discussed. Nosocomial-acquired respiratory syncytial virus infections in pre-term infants in Neonatal Intensive Care Units (NICUs) are reported. The development of an RSV vaccine has been challenging, and vaccine in pre-term infants is currently unavailable. Palivizumab, a monoclonal antibody licensed for the prevention of RSV, lowers respiratory tract disease in pre-term infants. The home healthcare nurse can play an important role. By developing patient and caregiver trust, the nurse can implement an RSV prevention plan, leading to a decrease in the hospitalization of premature infants with RSV.
Conclusions: Commercially-insured late pre-term infants with RSV infection are at high risk of recurrent wheezing and infantile asthma for 1 year after the initial episode, and pose a significant economic burden on the healthcare system. Education is critical for the continuing development of clinical NICU nursing practice.
Objectives: The aim of this study was to evaluate the usefulness of different cutoffs applied to the cellularity and various biochemical parameters (BP) (metabolic and enzymatic) to contribute to the etiologic diagnosis of pleural fluids (PF).
Design and Methods: We studied 150 samples from patients with pleural effusion, admitted to the Clinical Hospital. The cell count was total/mm3 (TCC) and differential. The simultaneous determination in pleural fluid (PF) and serum (S) of BP were performed on Roche Hitachi 917 autoanalyzer: Glucose (GLU), protein (PT), albumin (ALB), cholesterol (COL), triglycerides (TG), lactate dehydrogenase (LDH), creatine kinase (CK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (FAL), amylase (AMI), total bilirubin (BT). Statistical methods were c² and Fisher. A value of p<0.05 was considered significant.
Results: The most common cause of PF among transudates (T) was the heart failure (26%). In exudates (E), infections (43%) and cancer (25%) were the most frequent causes of PF. A TCC ≥ 500 cells/mm3 increased the detection of exudates without affecting the detection of transudate- type fluids. The PF / S ratio of LDH was the most useful among all BP in differentiating between T and E. PT, ALB, COL PF / S relations, and BT value > 0.5 mg / dl would be also suitable for differentiating T and E, and to a lesser extent PF / S for CK, AMI and SAAG. GLU value < 60 mg / dl showed no utility except in empyema. ALP, AST and ALT did not allow differentiating exudates from transudates.
Conclusions: The use of a new cutoff for the TCC ≥ 500 cells / mm3 in the differential diagnosis of PF is suggested. Different BP contributed to the differentiation between E and T.
Aims: Narrowing of the upper airway during sleep causes snoring, hypoventilation and decreased oxygenation of the brain with recurrent arousal from sleep and a cascade of excessive daytime sleepiness, poor concentration in class and undesirable academic performance. This study determined the prevalence of day time sleepiness among students in secondary schools in Ibadan and establishes its association with body mass index, tonsil size, Mallampati score, and academic performance.
Study Design: A prospective, cross sectional community based study.
Place and Duration of Study: Ibadan town, Nigeria between August 2013 and July 2014.
Methodology: This school-based cross-sectional study recruited the students by systematic random sampling technique. The participants answered an interviewer assisted structured questionnaire and had clinical examination for structural abnormalities of the oropharynx, Mallampati score, tonsillar grade and the BMI. The academic performances were determined using the overall mean average score of all the subjects offered during the first and second term of the academic session. The test of association between daytime sleepiness and other variables were determined. Statistical analysis of the data was done with Statistical Package for Social Sciences (SPSS) version 16.
Results: There were 493 participants consisting 262 (53.1%) males and 231(46.9%) females (M: F ratio of 1.1:1), the mean age was 12.6 years + 2.6 (range = 9-17 years) and the mean BMI was 22.60 kg/m2±3.0 (range= 15.7 - 35.2 kg/m2). Daytime sleepiness was encountered in 56 (11.4%) of the students, this was association with high Mallampati score (p < 0.001), high BMI (p < 0.001), but had no association with academic performance (p = 0.54), tonsillar enlargement (p = 0.35), gender (0.82) and overnight sleeping duration (p = 0.21).
Conclusion: The prevalence of daytime sleepiness among the secondary school students was 11.4%, and had no associated with academic performance. High BMI and Mallampati score were the significant risk factors identified.
Aim: The aim of this study was to compare two tubulization techniques, inside-out veins and standard veins, both filled with skeletal muscle or not, in sciatic nerve by morphological and histomorphometric study.
Methodology: Seventy Wistar rats were divided in 4 experimental groups (IOVNF - inside-out vein with no filling; IOVSM - inside-out vein filled with skeletal muscle; SVNF - standard vein with no filling; and SVSM - standard vein filled with skeletal muscle) and a control group (Sham). The left external jugular vein was sectioned into about 14 mm segments to be used as autologous vein grafts. A 10 mm gap was then created in the sciatic nerve and the vein graft was inserted into the vein with or without filling of the right caudal tibial muscle. The animals were euthanized 12 weeks after surgery.
Results: Myelinated and unmyelinated nerve fibers were observed in the histological analyses for all groups, as well as neoformation of the perineurium and intraneural organization of fascicles and blood vessels. In the morphometric analysis of the distal stump, regarding the myelin sheath area, all groups had a significant difference. The IOVNF group had the highest means for fiber, axon and myelin sheath areas. The SVSM group had the lowest means in all features measured, except for the axon area (4.95±1.72 graft; 3.71±0.90 distal stump).
Conclusion: These results show that sciatic nerve repair with inside-out veins and no filling (IOVNF) had the best results, in the majority of measured variables, when compared to the other groups.
Background: Lactation mastitis is a painful, debilitating condition that if not well managed, can mislead women into prematurely stopping breastfeeding and by so doing deprive the child of optimal feeding. The World Health Organization (WHO) estimates that about 10% of breastfeeding mothers worldwide develop mastitis, though incidence may vary between 2.6% and 33%.
Objective: The aim of this study is to determine the prevalence and risk factors of lactation mastitis among breastfeeding mothers in three hospitals in Cameroon.
Patients and Methods: This was an observational, cross-sectional prospective study of 245 breastfeeding women in three hospitals in Douala and Limbe during the period January 1, 2012 to December 31, 2012. Participants who had opted for breastfeeding were recruited and invited to complete a baseline questionnaire before discharge from hospital. Cases of mastitis were either reported directly to the researchers or diagnosed clinically. Regular telephone follow-up interviews were done for women diagnosed with mastitis.
Results: A total of 37 (15%) women were diagnosed with mastitis. Seventy-one percent (174/245) of them were not aware of breastfeeding techniques and did not practice standard breastfeeding habits. 42% practiced poor breastfeeding hygiene.
Conclusion: Approximately one in seven women is likely to have mastitis during breastfeeding. Most of the women are not aware of breastfeeding techniques and practice substandard breastfeeding hygiene that predisposes them to mastitis and to possible premature cessation of breastfeeding. In such circumstances, the method’s nutritional, immunological and economic benefits are lost.
Background: Biobanking today plays a key tool in biomedical research. Establishment and proper running of biobanks in developing countries is confronted with a number of challenges of legal, ethical, and financial nature. Considering that there are no guidelines or regulations to control biobanking in Egypt; major ethical issues arise and are often managed by research ethics committees (RECs). Pathologists are the custodians of tissue samples in different universities and hospitals; they have an important role in advancement of scientific research. So, they have to equip themselves adequately to manage the evolution of pathology work towards integration of biomarker analysis in clinical research and to deal with the ethical and legal issues of biobanks in Egypt.
Objective/Aim: The purpose of this review is to highlight the current situation of human tissue research and biobanking in Egypt with Comparative policy of other countries. We will address the role of pathologists and the difficulties and challenges facing the process of initiating biobanks and give some recommendations that might help different stakeholders for biobanking in Egypt.
Conclusion: Egypt is one of the developing countries which are in need to implement biobanks to improve the quality of research. The review highlights the different challenges facing biobanks in Egypt, mainly: lack of legislations, consent form, public trust, tissue transfer and commercialization. It also discuss the role of pathologists and research ethics committees in establishing and maintaining the work in these biobanks; and to make every effort for the interests of the participants, community and scientific progress, hopefully for good future biomedical research in Egypt.